Application for Rockfish Cooperative Fishing Quota

Revised: 09/29/06 OMB No. 0648-0545

Expiration date: 7/31/2009

Application for Rockfish Cooperative Fishing Quota (CQ)				U.S. Dept. of Commerce/ NOAA National Marine Fisheries Service Restricted Access Management P.O. Box 21668 Juneau, AK 99802-1668 (800) 304-4846 toll free / 586-7202 in Juneau (907) 586-7354 fax
A Rockfish Cooperative that submits a complete application that is approved by NMFS will receive a CQ permit that establishes an annual amount of primary rockfish species, secondary species, and rockfish halibut PSC that is based on the collective rockfish QS of the LLPs assigned to the rockfish cooperative by its members. A CQ permit will list the amount of CQ, by fishery, held by the Rockfish Cooperative, the members of the Rockfish Cooperative and LLP licenses assigned to that rockfish cooperative, and the vessels which are authorized to harvest fish under that CQ permit.
This application must be submitted annually by each Rockfish Cooperative and received by NMFS no later than March 1.
BLOCK A – ROCKFISH COOPERATIVE IDENTIFICATION
1. Rockfish Cooperative's legal name					2. Type of business entity under which the Rockfish Cooperative is organized
3. Date of Incorporation	4. Tax ID number *				5. State in which the Rockfish Cooperative is legally registered as a business entity
6. Printed name of authorized representative			7. Permanent business address
8. Business telephone number		9. Business FAX number				10. E-mail address (if available)
11. Signature of representative and date signed.

*The Debt Collection Improvement Act, in Section 7701 of title 31, United States Code requires collection of this information from each person doing business with a federal agency. This information is used for purposes of collecting and reporting any delinquent amounts arising out of such person’s relationship with the government.

BLOCK B – MEMBERS OF THE ROCKFISH COOPERATIVE
HARVESTER IDENTIFICATION
1. Full name	2. NMFS Person ID
	3. LLP number(s)
	4. Tax ID or SSN*
5. Vessel Name (on which CQ issued to rockfish cooperative will be used)	6. ADF&G Vessel No.
	7. USCG No.
LLP HOLDERSHIP DOCUMENTATION
Enter the names of all persons, to the individual level, holding an ownership interest in the LLP license(s) assigned to the rockfish cooperative and the percentage ownership each person and individual holds in the LLP license(s).
Name		% Ownership in LLP License

BLOCK C -- PROCESSOR ASSOCIATES OF THE ROCKFISH COOPERATIVE
IDENTIFICATION
1. Full name	2. NMFS Person ID
	3. Tax ID*
Processing Facility
4. Name	5. ADF&G processor code
	6. Federal processor permit No.
Stationary Floating Processor
7. Name	8. ADF&G processor code
	9. Federal processor permit No.
	10. USCG number
PROCESSOR OWNERSHIP INFORMATION
Provide the names of all persons, to the individual level, holding an ownership interest in the processor and the percentage ownership each person and individual holds in the processor.
Name		% Ownership in Processor
ATTACHMENTS
For the cooperative application to be considered complete, the following documents must be attached to the application: o A copy of the business license issued by the state in which the Rockfish Cooperative is registered as a business entity; o A copy of the articles of incorporation or partnership agreement of the Rockfish Cooperative; o A copy of the Rockfish Cooperative agreement signed by the members of the Rockfish Cooperative (if different from the articles of incorporation or partnership agreement of the Rockfish Cooperative). o Any article of incorporation or agreement submitted by the Rockfish Cooperative must include terms that specify that eligible rockfish processor affiliated harvesters do not participate in price setting negotiations except as permitted by general antitrust law and the Rockfish Cooperative has established a monitoring program sufficient to ensure compliance with the Rockfish Program.

BLOCK D - CERTIFICATION OF APPLICANT
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, the information is true, correct, and complete.
1. Signature of Applicant (or Authorized Representative)	2. Date Signed
3. Printed Name of Applicant (or Authorized Representative); if representative, attach authorization

______________________________________________________________________________________________________________

PUBLIC REPORTING BURDEN STATEMENT

Public reporting burden for this collection of information is estimated to average 2 hours per response, including the time for reviewing the instructions, searching the existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Assistant Regional Administrator, Sustainable Fisheries Division, NOAA National Marine Fisheries Service, P.O. Box 21668, Juneau, AK 99802-1668.

ADDITIONAL INFORMATION

Before completing this form, please note the following: 1) Notwithstanding any other provision of law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number; 2) This information is mandatory and is required to manage commercial fishing efforts under 50 CFR part 679 and under section 402(a) of the Magnuson-Stevens Act (16 U.S.C. 1801, et seq.); 3) Responses to this information request are confidential under section 402(b) of the Magnuson-Stevens Act. They are also confidential under NOAA Administrative Order 216-100, which sets forth procedures to protect confidentiality of fishery statistics.

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Instructions for

Application for Rockfish CQ

A Rockfish Cooperative that submits a complete application and that is approved by NMFS will receive a Rockfish Cooperative allocation that establishes an annual catch limit of primary and secondary species based on the collective catch history holdings of the LLPs held and contributed by the members of the Rockfish Cooperative. A Rockfish Cooperative allocation will list the amount of allocation, by fishery, held by the Rockfish Cooperative and identify the members of the Rockfish Cooperative.

Type or print legibly in ink; retain a copy of completed application for your records. Completed forms should be mailed or faxed to:

NMFS Alaska Region

Restricted Access Management

P.O. Box 21668

Juneau, AK 99802-1668

FAX: (907) 586-7354

If you need additional information, contact Restricted Access Management at

(800) 304-4846 (#2) or (907) 586-7202 (#2).

Please allow at least 10 working days for your application to be processed. Items will be sent by first class mail, unless you provide alternate instructions and include a prepaid mailer with appropriate postage or corporate account number for express delivery.

Submit a completed application for a Rockfish Cooperative allocation, including all amendments, such that they are received by NMFS no later than March 1 to receive an allocation that may be used during the calendar year.

BLOCK A – ROCKFISH COOPERATIVE IDENTIFICATION

Legal name

Type of business entity under which organized

State in which legally registered as a business entity

Tax ID number* (required)

*The Debt Collection Improvement Act, in Section 7701 of title 31, United States Code requires collection of this information from each person doing business with a federal agency. This information is used for purposes of collecting and reporting any delinquent amounts arising out of such person’s relationship with the government

Date of Incorporation

Printed name and signature of designated representative and date signed

Permanent business address, telephone number, facsimile number, and e-mail address (if available)

BLOCK B – MEMBERS OF ROCKFISH COOPERATIVE

Harvester identification

Full name and NMFS Person ID

LLP license number(s)

Tax ID number or social security number*

Name, Alaska Department of Fish and Game (ADF&G) vessel registration number, and

United States Coast Guard (USCG) documentation number of vessel(s)

LLP Holdership Documentation

Names of all persons, to the individual level, holding an ownership interest in the

License Limitation Program (LLP) license(s) assigned to the rockfish cooperative

Percentage ownership each person and individual holds in the LLP license(s).

Processor associates of the rockfish cooperative

Full name and NMFS Person ID

Tax ID number*

Shoreside facility

Name, ADF&G processor code, and Federal processor permit (FPP) number

Stationary floating processor

Name, ADF&G processor code, FPP number, and USCG documentation number

Processor ownership documentation

Names of all persons, to the individual level, holding an ownership interest in the processor

Percentage ownership each person and individual holds in the processor.

BLOCK C – ATTACHMENTS

For the cooperative application to be considered complete, the following documents must be

attached to the application.

A copy of the business license issued by the state in which the Cooperative is registered as a

business entity

A copy of the articles of incorporation or partnership agreement of the Rockfish Cooperative

A copy of the agreement signed by the members of the Rockfish Cooperative (if different from

the articles of incorporation or partnership agreement)

Any article of incorporation or agreement submitted by the Rockfish Cooperative must include

terms that specify that:

The eligible processor does not participate in price setting negotiations except to the extent

permitted by general antitrust law; and

The Rockfish Cooperative has established a monitoring program sufficient to ensure

compliance with the Rockfish Pilot Program.

BLOCK D -- APPLICANT CERTIFICATION

The applicant must sign and date the application certifying that all information is true, correct, and complete

to the best of his/her knowledge and belief. If the application is completed by an authorized representative,

then explicit authorization signed by the applicant must accompany the application.

Application for Rockfish CFQ

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